Physical Activity and Risk of Atrial Fibrillation: A Nationwide Cohort Study in General Population
Open accessAbstract
Although exercise prevents cardiovascular disease and mortality, vigorous exercise and endurance athletics can cause atrial fibrillation (AF). However, no large cohort study has assessed the relationship between physical activity and AF in the general population. We assessed the effect of physical activity at different energy expenditures on the incidence of AF. We studied 501,690 individuals without pre-existing AF (mean age, 47.6 ± 14.3 years; 250,664 women [50.0%]) included in the Korean National Health Insurance Service database. The physical activity level was assessed using a standardized self-reported questionnaire at baseline. During a median follow-up of 4 years, 3,443 participants (1,432 women [41.6%]) developed AF. The overall incidence of AF at follow-up was 1.79 per 1,000 person-years. The subjects who met the recommended physical activity level (500–1,000 metabolic equivalent task [MET] minutes/week) had a 12% decreased AF risk (adjusted hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.80–0.97), but not the insufficiently (1–500 MET-minutes/week; HR: 0.94, 95% CI: 0.86–1.03) and highly active subjects (≥1,000 MET-minutes/week; HR: 0.93, 95% CI: 0.85–1.03). The recommended minimum key target range of physical activity level was associated with the maximum benefit for reduced AF risk in the general population. The dose-response relationship between physical activity level and AF risk showed a U-shaped pattern. Although exceeding the key target range attenuated this benefit, it did not increase the AF risk beyond that during inactivity.
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Lack of physical activity and long-term vigorous exercise both increase the risk of developing atrial fibrillation, suggesting a U-shaped curve.
“with studies suggesting a U-shaped curve, with lack of physical activity and long-term vigourous exercise both increasing the risk of developing AF. 10 11”
From Risk of atrial fibrillation in athletes: a systematic review and meta-analysis (2021) · cites this paper as [11]
The Introduction reports reduced AF risk with moderate activity and increased risk with high-intensity or endurance exercise in younger athletes and middle-aged men, supporting the suggested curve for those groups. The Results (Physical activity and AF) found that activity above 1,000 MET-minutes/week was not associated with higher risk than inactivity, so this paper does not establish increased risk at both extremes in the general population. Page numbers were not supplied in our copy. (LLM, conf=0.86)
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“1 3 respectively, which is in accordance with a previous study [27] using the same database and is in accordance to the International Physical Activity Questionnaire MET values.”
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“On the other hand, a beneficial effect of physical exercise on the risk for hospitalization for cardiovascular diseases, including peripheral vascular disease (25) and heart failure, coronary heart disease (26), atrial fibrillation (27), and cerebrovascular disease (28) is well established.”
BackgroundDay-to-day measurement of physical activity and risk of atrial fibrillation
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“Some studies indeed found a U-shaped relationship between physical activity and AF incidence and progression, so our study, despite its observational nature, may contribute to additional knowledge on the benefits of physical activity [26,28].”
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“1% of the positive predictive value.(16,17)”
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Long-Term Sports Practice and Atrial Fibrillation: An Updated Review of a Complex Relationship
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“Some papers [23,24] report that the relationship between AF and sport may be a “U-shaped” relationship whereby both a sedentary lifestyle and strenuous, long-duration PA may prove to be risk factors for AF.”
BackgroundAssociations of Dietary and Lifestyle Components with Atrial Fibrillation
Leszto, K., Frąk, W., Kurciński, S., Sinkowska, J., Skwira, S., Młynarska, E., Rysz, J., & Franczyk, B. (2024) · Nutrients · doi:10.3390/nu16030456 · Cited by 15 · see citing works
“Some studies reported that high activity in females could be beneficial for AF prevention, as opposed to the male population [28,30,31].”
BackgroundManaging athletes with palpitations of unknown origin with an external loop recorder: A cohort study
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“Moderate regular exercise seems to mitigate AF risk in both sexes, while vigorous endurance exercise may increase it, especially in male athletes [43, 44].”
BackgroundAtrial Fibrillation in Endurance Training Athletes: Scoping Review
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Advances in Atrial Fibrillation Management: A Guide for General Internists
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Risk Factor Management Before and After Atrial Fibrillation Ablation
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“…[46]; hence further research is required to speci fi cally assess the factors that contribute to blood pressure control, ranging from medication adherence, physical activity, to dietary salt intake and the proportion of food consumed by patients that all may play a role in AF development [47, 48].”
Choi, J., Lee, S., Choi, E., Lee, K., Ahn, H., Kwon, S., Han, K., Oh, S., & Lip, G. Y. H. (2024) · Cardiovascular Diabetology · doi:10.1186/s12933-024-02194-2 · Cited by 10 · see citing works
“[41] A potential explanation for the varying effects of physical activity on different DM durations could be changes in the autonomic nervous system.”
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“Method was based on a cutoff of 1,000 MET-min, distinguishing between intensive physical activity [26].”
MethodSelf-citationWeekly physical activity and incident atrial fibrillation in females – A dose-response meta-analysis
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“There has been found a higher risk of AF in those who had less than 500 or greater than 1000 MET-mins/wk exercise.(166) This lowered risk decrease in this study was not consistent with the current literature.”
ResultImpact of atrial fibrillation and atrial fibrillation therapies on sports performance in athletes
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Differences in the Effect of Physical Activity on the Prevention of Gastric Cancer According to Sex
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Role of ideal cardiovascular health metrics in reducing risk of incident arrhythmias
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Exercise Testing in Elite Athletes
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“Different studies show that the relationship between exer - cise dose and the relative risk of developing AF seems to be a U-shaped curve, as being inactive and being highly active are both risk factors [4, 5].”
Endurance Exercise Induced Atrial Fibrillation (AF): Pathophysiology, Treatment and Prevention
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“However, the dose-response association between exercise volumes and health outcomes is characterized by a U-shaped or reverse J-shaped curve [26,37,43,66,67].”
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“0.634 MET-minutes/week 284.1 ± 416.0 281.8 ± 397.4 311.8 ± 425.9 0.016 292.5 ± 476.5 278.7 ± 466.5 0.177 Systolic BP, mmHg 122.2 ± 15.3 120.3 ± 14.5 124.7 ± 15.7 0.001 129.2 ± 16.0 130.5 ± 17.2 0.001 Diastolic BP, mmHg 76.1 ± 10.2 75.5 ± 10.2 78.3 ± 10.5 0.001 78.1 ± 10.1 78.9 ± 10.7 0.002 Hemoglobin, g/dL 13.9 ± 1.6…”
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“Thus, a U-shaped dose–response relationship was highlighted [46].”
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“20 Furthermore, these studies employed relatively short follow-up durations without inclusion of lag periods, which precluded assessment of surveillance effects on the observed associations.”
Atrial fibrillation among master athletes: A complex relationship
Sciarra, L., D’Ascenzi, F., Borrelli, A., Santarelli, M., Fusari, M., Scognamiglio, D., Zanin, F., Pignalosa, L., Spiriti, G., Petrungaro, M., et al. (2026) · International Journal of Cardiology · doi:10.1016/j.ijcard.2026.134212 · Cited by 2 · see citing works
Atrial Fibrillation in Athletes
Alameh, I. A., Fout, G. A., Ezekowitz, M. D., & Kamareddine, M. H. (2026) · JACC Case Reports · doi:10.1016/j.jaccas.2026.107061 · Cited by 3 · see citing works
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“We also compared insufficient physical activity group (0 and 1–500 MET-min/week) to sufficient physical activity group (> 500 MET-min/week).”
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“The participants were stratified according to their total weekly levels of physical activity as follows: (1) highly active group: physical activity exceeding the guideline target range (≥1000 MET-min/week); (2) active group: physical activity within the guideline target range (500–999 MET-min/week); (3) insufficiently…”
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Self-citationAtrial Fibrillation and Lifestyle Modification: Charting New Courses for Cardiovascular Health
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Sport et cœur : où est la limite ?
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Objective and Subjective Assessments of Exercise Burden in Masters Athletes Are Poorly CorrelatedPreprint
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Research Progress on Modifiable Risk Factors of Atrial Fibrillation
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Racial and Gender Differences in Cardiorespiratory Fitness and Atrial Fibrillation
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Are Subjective Reports of Exercise Intensity Accurate in Recreational Athletes?
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Self-citationPhysical Activity, Exercise, and Heart Disease
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Ratio of Left Atrial and Ventricular Volume as New Marker of Atrial Cardiopathy and Stroke Risk
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“In this study patients who were physically inactive had 4.21 times odds of AF which was consistent with previous study done in Korea that showed individual who were physical active had lower risk of AF when compared to physically inactive individuals [80].”
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Self-citation
- Authors
- Jin, M.-N., Yang, P.-S., Song, C., Yu, H. T., Kim, T.-H., Uhm, J.-S., Sung, J.-H., Pak, H.-N., Lee, M.-H., & Joung, B.
- Affiliations
- Yonsei University (KR)
- CHA University Bundang Medical Center (KR)
- Corresponding author
- Joung, Boyoung
- ORCID
- Venue
- Scientific Reports
- Published
- 2019-09-13
- Volume
- 9
- Issue
- 1
- Pages
- 13270-13270
- ISSN
- 2045-2322 (ISSN-L)
- PMC
- PMC6744571
- OpenAlex
- W2972714021
- Cited by
- 99
- References
- 40
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 27 · 2023: 15 · 2022: 10 · 2021: 20 · 2020: 8
- FWCI
- 6.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Scientific Reports (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
- Funders
- National Research Foundation of Korea (NRF-2017R1A2B3003303)
- Ministry of Health and Welfare (HI16C0058, HI15C1200)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- physical activity, atrial fibrillation, atrial fibrillation incidence, energy expenditure, dose-response relationship, U-shaped curve, physical inactivity, recommended physical activity levels, general population
- MeSH terms
- Atrial Fibrillation, Female, Humans, Male, Middle Aged, Prognosis, Risk Factors, Cohort Studies, Exercise, Incidence, Republic of Korea
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